We report the functional and socioeconomic long-term
outcome of patients with pelvic ring injuries. We identified 109 patients treated at a Level I trauma centre
between 1973 and 1990 with multiple blunt orthopaedic injuries including
an injury to the pelvic ring, with an Injury Severity Score (ISS)
of ≥ 16. These patients were invited for clinical review at a minimum
of ten years after the initial injury, at which point functional
results, general health scores and socioeconomic factors were assessed. In all 33 isolated anterior (group A), 33 isolated posterior
(group P) and 43 combined anterior/posterior pelvic ring injuries
(group A/P) were included. The mean age of the patients at injury
was 28.8 years (5 to 55) and the mean ISS was 22.7 (16 to 44). At review the mean Short-Form 12 physical component score for
the A/P group was 38.71 (22.12 to 56.56) and the mean Hannover Score
for Polytrauma Outcome subjective score was 67.27 (12.48 to 147.42),
being significantly worse compared with the other two groups (p =
0.004 and p = 0.024, respectively). A total of 42 patients (39%)
had a limp and 12 (11%) required crutches. Car or public transport
usage was restricted in 16 patients (15%). Overall patients in groups
P and A/P had a worse outcome. The long-term outcome of patients
with posterior or combined anterior/posterior pelvic ring injuries
is poorer than of those with an isolated anterior injury. Cite this article:
A wide variety of intra- and extramedullary devices for the treatment of trochanteric fractures has been described. The Percutaneous Compression Plate is a minimally invasive and extramedullary device, which requires two 2–2.5 cm long incisions with minimal dissection oft soft tissue on the lateral aspect of the proximal femur. Earlier studies indicated that internal fixation using the PCCP is associated with a decreased perioperative blood loss, reduced transfusion requirements, with less postoperative pain, more rapid mobilisation, and with a reduced incidence of collapse of the fracture when compared with the standard device Dynamic Hip Screw. Aim of this study is to analyze the risk factors for the occurrence of local complications after internal fixation of intertrochanteric fractures of the femur using a Percutaneous Compression Plate. In a retrospective cohort study patients with trochanteric fractures who underwent internal fixation with a PCCP were included. We investigated the potential risk factors age, gender, experience of the surgeon as indicated by the numbers of surgical procedures with the PCCP device, stability of the fracture according to the AO/OTA classification, and co-morbidities of the patients according to the ASA classification. The operations were performed by ten different surgeons. All local complications which required re-operation were recorded. They included cutting out of the screw, loosening of the screw barrels, local haematoma, and infections. Logistic regression analysis was carried out to determine the risk factors for local complications. The mean age of the 122 patients included in this study was 78.5 years. 87 patients were female (70.7 %), 36 patients were male (29.3 %). With respect to the stability of the fracture 64 trochanteric fractures (52.5%) were classified as stable according to the AO/OTA classification, whereas 58 (47.5%) were considered to be unstable. Of the total of 122 patients with 122 trochanteric fractures eleven underwent re-operation due to local complications (9 %). The most frequent complication was complete or imminent cutting out of the upper cervical screw (N=5; 4 %). In the multivariate logistic regression model the only statistically significant risk factor was the experience of the surgeon (p=0.0316; odds ratio=4.7; CI 1.1–19.4). Our data indicate that the experience of the surgeon is a significant risk factor for the occurrence of local complications. The frequent use of this device seems to lower the re-operation rate.
Aim of this study was to find out which factors influence the outcome after both column fractures of the acetabulum. We performed a retrospective analyse of 115 patients with both column acetabular fractures. The period between the injury and follow-up ranges between 2 and 19 years, 5,7 years on average. The initial displacement, the presence of a dislocation of the hip and fractures of the femoral head were analyzed on the initial radiographs. Postoperative displacement was classified according the classification of Matta. The common classifications of Helfet (posttraumatic arthrosis), Ficat/Arlet (femur head necrosis) and Brooker (periarticular calcification) were used to radiologically classify the long term results. Statistics were performed by the Chi-square-test.Aim of the study
Methods
The additive use of an external modular device may improve dorsal compression forces in pelvic external fixation. This would improve the efficiency of indirect reduction and stabilization with an anterior pelvic external fixator. The purpose of this study was to determine the forces of the posterior pelvis achieved by a new device improving the application of a supraacetabular anterior external fixator compared with other constructs. Synthetic pelvic models were used. Complete pelvic ring instability was created by symphyseal and unilateral sacroiliac joint disruption. Four different constructs of fixation were tested. A pressure-sensitive film was placed in the sacroiliac joint. The constructs were applied in a standardized way. The maximum sacroiliacal compression loads (N) of each trial was recorded. Statistics was performed with the student t-test.Objectives
Material and Method
Overlooked compartment syndrome represents a devastating complication for the patient. Invasive compartment pressure measurement continues to be the gold standard. However, repeated measurements in uncertain cases may be difficult to achieve. We developed a new, noninvasive method to assess tissue firmness by pressure related ultrasound. Decreased tissue elasticity by means of rising compartment pressures was mimicked by infusion of saline directly into the anterior tibial compartment of 6 human specimens post mortem. A pressure transducer (Codman) monitored the pressure of the anterior tibial compartment. A second transducer was located in a saline filled ultrasound probe head to allow a simultaneous recording of the probe pressure provoked by the user. The ultrasound images were generated at 5 and 100mmHg probe pressures to detect the tissue deformity by B-mode ultrasound. The fascial displacement was measured before and after compression (d). Subsequently, increments of 5mmHg pressure increases were used to generate a standard curve (0–80mmHg), thus mimicking rising compartment pressures. The intra-observer reliability was tested using 10 subsequent measurements. A correlation was determined between d and the simulated intacompartmental pressure (ICP) in the compartment. The Pearson correlation coefficient (r) was calculated. The reliability determined by the kappa value and a regression analysis was performed.Background
Methods
